RCM tip: Invest in automated rules engine to improve RCM

Investing in automation tools, such as a rules engine, can help healthcare organizations decrease their administrative workload, according to Andrew Wade, practice administrator at Conway, S.C.-based Coastal Orthopedics.

Mr. Wade shared the following tip with Becker’s Hospital Review:

“If we want to truly free up providers from administrative burden and empower them to do the work they love to do — spending more time with patients and delivering quality care — organizations need to invest in tools that automate tasks wherever possible. Thanks to our technology’s rules engine, our claims can be automatically verified and some errors automatically resolved based on knowledge gleaned from the network. We are getting cleaner claims out the door, decreasing our accounts receivable to 31 days and dipping our denial rate down to 9.8 percent over the last four months, giving us the best claim-to-cash conversion ratio we’ve ever had. Our money isn’t playing jump-through-the-hoop with the insurance companies anymore.” …

Continue reading this article

View all Articles by: Melissa Clark, CCS-P